Long-Term Oxygen Therapy 24 vs 15 h-day and Mortality in Chronic Obstructive Pulmonary DiseaseReportar como inadecuado

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Long-term oxygen therapy LTOT ≥ 15 h-day improves survival in hypoxemic chronic obstructive pulmonary disease COPD. LTOT 24 h-day is often recommended but may pose an unnecessary burden with no clear survival benefit compared with LTOT 15 h-day. The aim was to test the hypothesis that LTOT 24 h-day decreases all-cause, respiratory, and cardiovascular mortality compared to LTOT 15 h-day in hypoxemic COPD. This was a prospective, observational, population-based study of COPD patients starting LTOT between October 1, 2005 and June 30, 2009 in Sweden. Overall and cause-specific mortality was analyzed using Cox and Fine-Gray regression, controlling for age, sex, prescribed oxygen dose, PaO2 air, PaCO2 air, Forced Expiratory Volume in one second FEV1, WHO performance status, body mass index, comorbidity, and oral glucocorticoids. A total of 2,249 included patients were included with a median follow-up of 1.1 years interquartile range, 0.6–2.1. 1,129 50% patients died and no patient was lost to follow-up. Higher LTOT duration analyzed as a continuous variable was not associated with any change in mortality rate hazard ratio HR 1.00; 95% confidence interval CI, 0.98 to 1.02 per 1 h-day increase above 15 h-day. LTOT exactly 24 h-day was prescribed in 539 24% patients and LTOT 15–16 h-day in 1,231 55% patients. Mortality was similar between the groups for all-cause, respiratory and cardiovascular mortality. In hypoxemic COPD, LTOT 24 h-day was not associated with a survival benefit compared with treatment 15–16 h-day. A design for a registry-based randomized trial R-RCT is proposed.

Autor: Zainab Ahmadi , Josefin Sundh, Anna Bornefalk-Hermansson, Magnus Ekström

Fuente: http://plos.srce.hr/


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